PURPOSE: Experimental evidence suggests that phosphodiesterase type 5 inhibitors (PDE5i) may suppress tumor growth, postpone metastasis, and prolong survival, but clinical data are lacking.
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We studied the effect of PDE5i on biochemical recurrence (BCR) after radical prostatectomy for prostate cancer.
MATERIALS AND METHODS: The study comprised of 4752 consecutive patients with localized prostate cancer treated by bilateral nerve-sparing radical prostatectomy between January 2000 and December 2010. Of these, 1110 (23.4%) patients received PDE5i (PDE5i group) postoperatively while 3642 (76.6%) did not (non-PDE5i group). The risk of biochemical recurrence (BCR) was compared between the PDE5i and non-PDE5i group. Cox multivariate proportional hazard models and confidence intervals were used to estimate the hazard ratio of BCR associated with PDE5i use. Propensity score-matched analysis was performed.
RESULTS: Median follow up was 60.3 months (IQR 36.7 - 84.5). Five-year BCR-free survival estimates in the PDE5i versus non-PDE5i patients were 84.7% (95% CI: 82.1% - 87.0%) and 89.2% (95% CI: 88.1 - 90.3%) (p=0.0006), respectively. Multivariate regression analysis showed that PDE5i use was an independent risk factor for BCR (HR: 1.38, CI: 1.11 - 1.70; p=0.0035). This was also true after propensity score matching.
CONCLUSIONS: Contrary to experimental data, use of PDE5i post prostatectomy may adversely impact BCR following radical prostatectomy. Further studies are needed to validate our results.
Michl U, Molfenter F, Graefen M, Tennstedt P, Ahyai S, Beyer B, Budäus L, Haese A, Heinzer H, Oh SJ, Salomon G, Schlomm T, Steuber T, Thederan I, Huland H, Tilki D. Are you the author?
Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Reference: J Urol. 2014 Sep 4. pii: S0022-5347(14)04366-3.